How Good Was The Evidence
- There was a high risk of bias in many of the papers included, as many were not blinded, had limited sequence generation and allocation concealment
- There was poor reporting of adverse events therefore it was not possible to ascertain the incidence of adverse events with confidence
- Approximately half of the trials were industry funded half were funded by Pfizer and half by other manufacturers
- Publication bias was assessed as not significant
This review helps clarify the relationship between the dose of Atorvastatin and the effect it has on cholesterol levels, which will allow for a more factual and open discussion between clinicians and patients about the expected effects of their medication.
How To Take And Store
Lipitor can be taken with or without food. It is quickly absorbed, reaching its peak concentration in the blood within about two hours. Lipitor starts to lower cholesterol within about two weeks of starting the medication.
Lipitor should always be taken in conjunction with a diet to lower your cholesterol and triglycerides.
Store the tablets at a controlled room temperature that’s ideally 68 to 77 degrees F.
If you miss a dose of Lipitor, take it as soon as you remember. But if it has been more than 12 hours since the missed dose, skip it and just take your next scheduled dose. Do not take two doses at once.
If you take too much Lipitor or overdose, seek immediate medical care.
Combination Therapy And Compliance
Combination regimens should be considered for use in patients who fail to meet target values and are compliant with their current therapy. Patients with moderate to severe hypercholesterolemia generally have more difficulty reaching their goals, although considerable reductions in LDL do occur. If further reductions in LDL are required, and the benefits outweigh the risks, a statin in conjunction with niacin is an effective combination. More patients reach their lipid goals with a statin and niacin than with any other combination regimen.36 When the patent on lovastatin expires in 2001, a one-tablet combination of lovastatin with extended-release niacin is likely. Myopathy and rhabdomyolysis are serious concerns when statins are combined with fibrates or niacin. It is important for physicians to educate their patients about the adverse effects of these medications and instruct them to report muscle pain or tenderness immediately.
Compliance with bile acid sequestrants is a problem. Approximately one third of the patients for whom bile acid sequestrants are prescribed will not take the full dosage because of constipation or poor palatability.37 Combination therapies that include a bile acid sequestrant have lower success rates than other combinations.
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Liver Injuriesa Strong Warning Sign
Side effects from statin drugs can be serious. Side effects include muscle pain, muscle degeneration, joint pain, memory impairment, depression, gastrointestinal discomfort, kidney injury, kidney failure, and liver injury.7,8 These and other side effects may be mild or severe. According to Dr. William Davis, a cardiologist, The drug companies will tell you that the likelihood of side effects from statins is low. Nevertheless, many who prescribe these drugsand their patients who take themmay tell you otherwise. Like many of my colleagues, I have hundreds of patients who, when they take a statin agent, develop annoying, sometimes incapacitating muscle aches and weakness that abruptly stop when they discontinue use of the drug, and return when drug use is resumed. The association appears clear.9
|The risk of liver injury with statin drogs is dose-related.|
The risk of liver injury with statin drugs is also dose-related. Liver injuries with statins can be dangerous. Cases of liver failure and death with statin drugs have been reported to the FDA. In the TNT heart study, only nine subjects developed significant liver injury with low-dose Lipitor®, yet such findings occurred in 60 people receiving maximum-dose Lipitor®. In the stroke study, 51 people developed liver injury with maximum-dose Lipitor®, while only 11 developed liver injury with placebo.1 These are worrisome findings.
Muscle Pain And Weakness
The most common side effect is muscle pain and weakness, a condition called rhabdomyolysis, most likely due to the depletion of Co-Q10, a nutrient that supports muscle function. Dr. Beatrice Golomb of San Diego, California is currently conducting a series of studies on statin side effects. The industry insists that only 2-3 percent of patients get muscle aches and cramps but in one study, Golomb found that 98 percent of patients taking Lipitor and one-third of the patients taking Mevachor suffered from muscle problems.4 A message board devoted to Lipitor at forum.ditonline.com contained more than 800 posts, many detailing severe side effects. The Lipitor board at www.rxlist.com contains more than 2,600 posts .
The test for muscle wasting or rhabdomyolysis is elevated levels of a chemical called creatine kinase . But many people experience pain and fatigue even though they have normal CK levels.5
John Altrocchi took Mevacor for three years without side effects then he developed calf pain so severe he could hardly walk. He also experienced episodes of temporary memory loss.
Active people are much more likely to develop problems from statin use than those who are sedentary. In a study carried out in Austria, only six out of 22 athletes with familial hypercholesterolemia were able to endure statin treatment.9 The others discontinued treatment because of muscle pain.
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Are You A Candidate For A Statin
Guidelines from the American College of Cardiology and American Heart Association recommend statin therapy for:
- Secondary prevention in people with established atherosclerotic cardiovascular disease.
- People with an LDL cholesterol level of 190 milligrams per deciliter or higher, due to a genetic condition.
- People with diabetes ages 40 to 75 with an LDL level over 70 mg/dL and no atherosclerotic cardiovascular disease.
- Non-diabetic adults ages 40 to 75 with a 20% or greater likelihood of developing atherosclerotic cardiovascular disease in the next 10 years .
- Non-diabetic patients ages 40 to 75 with an LDL level of 70 to 189 mg/dL and a 10-year ASCVD risk of 7.5% to less than 20% if the risk estimate and presence of certain risk-enhancing factors* favor treatment.
* These factors include a family history of ASCVD, LDL levels persistently 160 mg/dL, triglyceride levels persistently 175 mg/dL, chronic kidney disease, ethnicity, inflammatory diseases, metabolic syndrome, and results of high-sensitivity C-reactive protein, lipoprotein, and apolipoprotein B. Note: The guidelines recommend considering coronary artery calcium scoring for people at intermediate risk in whom a decision about starting statin treatment remains uncertain.
Mechanisms Accounting For Bile Acid Sequestrants Induced Lipid Effects
Bile acid sequestrants bind bile acids in the intestine, preventing their reabsorption in the terminal ileum leading to the increased fecal excretion of bile acids . This decrease in bile acid reabsorption reduces the size of the bile acid pool, which stimulates the conversion of cholesterol into bile acids in the liver . This increase in bile acid synthesis decreases hepatic cholesterol levels leading to the activation of SREBPs that up-regulate the expression of the enzymes required for the synthesis of cholesterol and the expression of LDL receptors . The increase in hepatic LDL receptors results in the increased clearance of LDL from the circulation leading to a decrease in serum LDL-C levels . Thus, similar to statins and ezetimibe, bile acids lower plasma LDL-C levels by decreasing hepatic cholesterol levels, which stimulates LDL receptor production and thereby accelerates the clearance of LDL from the blood.
The mechanism by which treatment with bile acid sequestrants improves glycemic control is unclear .
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Does Atorvastatin Cause Liver Problems
Atorvastatin can cause liver damage. In clinical trials, liver toxicity was reported in less than 1% of patients overall, but was more common with higher doses. Statins are extensively metabolized by the liver. Your doctor will check your liver enzymes with a simple blood test before you start treatment with statins.
Liver problems might first be noticed on a blood test ordered by your doctor or you might have symptoms of liver disease. Enzyme blood levels may be high in your lab report. If these levels get to be about 3 times higher than normal, your doctor may decide to stop your medication, lower your dose, or change your medication to a different class.
If you notice symptoms of liver disease, such as severe fatigue or weakness along with loss of appetite, stomach pain, dark-colored urine or yellowing of skin or eyes, contact your doctor for medical advice immediately.
Can I drink alcohol while taking atorvastatin?
There is no specific drug interaction between alcohol and atorvastatin however, you may consider limiting your alcohol intake because statins plus excessive alcohol may raise your triglyceride levels and possibly lead to liver toxicity. If you drink more than 2 glasses of alcohol per day, discuss this with your doctor. High cholesterol and alcohol use can be linked if alcohol is consumed chronically and excessively.
Learn More: Cholesterol Medications and Alcohol Interactions
Other common side effects of atorvastatin
- memory loss
What Is The Maximum Dosage For Lipitor
The maximum dosage for Lipitor is 80 mg per day. However, patients taking cyclosporine should not take more than 10 mg per day, according to the manufacturers product label. Patients taking clarithromycin, cobicistat, itraconazole, darunavir plus ritonavir, fosamprenavir, or saquinavir plus ritonavir should not take Lipitor doses greater than 20 mg per day. Patients taking the HIV medication nelfinavir should not take doses of Lipitor greater than 40 mg per day. Generally, pediatric patients should not take more than 20 mg per day.
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How To Access Statins At A Lower Cost
It is clear that medications to treat high cholesterol can be very expensive. Here are some ways that you can get these medications at the lowest cost:
1) MiraRx: through Miraâs Prescription Portal, you search the name of the medication you need and your location. You will be presented with coupons you can use to get your prescription at the lowest cost. For example, you can get Atorvastatin for up to 73% off at pharmacies in New York City.
2) Look for generic medications: generic medications can be significantly cheaper than their name-brand counterparts. If you are prescribed a name-brand medication, you can call your doctor or pharmacist and ask if you can take a generic medication as a substitute. Sometimes there are differences between name brands and generic medications, but in most cases, the generic version of the medication can be substituted for the name brand.
When You Need Themand When You Dont
Your body makes a waxy substance called cholesterol. You also get it from food. Your body needs it, but too much cholesterol in your blood can clog your arteries. This increases your risk of heart disease, heart attack, and death.
Statins are drugs that lower your cholesterol. But if you are age 75 or older and you havent had symptoms of heart disease, statins may be a bad idea. Heres why:
Adults age 75 and older may not need statins.
Many older adults have high cholesterol. Their doctors usually prescribe statins to prevent heart disease.
But for older people, there is no clear evidence that high cholesterol leads to heart disease or death. In fact, some studies show the oppositethat older people with the lowest cholesterol levels actually have the highest risk of death.
Statins have risks.
Compared to younger adults, older adults are more likely to suffer serious side effects from using statins.
Statins can cause muscle problems, such as aches, pains, or weakness. Rarely, there can be a severe form of muscle breakdown.
In older adults, statins can also cause:
- Memory loss and confusion
- Nausea, constipation, or diarrhea.
Often, older adults take many drugs. These can interact with statins and lead to serious problems. Side effects, like muscle pain, may increase. Statins can also cause a fatal reaction when taken with heart-rhythm drugs.
Statins may increase the risk of type-2 diabetes and cataracts, as well as damage to the liver, kidneys, and nerves.
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Alternatives To Statins For Lowering Cholesterol
Your best treatment option for high cholesterol depends on many factors. Before your doctor recommends a prescription medication, they will look at several things, including your family medical history, your risk for heart disease, and your lifestyle.
Many doctors prefer to start with changes to diet and exercise. If those changes dont have enough effect, you might start taking medication to help the process along.
Statins are one commonly prescribed medication for controlling cholesterol, but these drugs might not be right for everyone. There are several treatment options for high cholesterol, including other medications and lifestyle changes.
What Does Atorvastatin Do To The Body
Atorvastatin works by reducing your “bad” cholesterol and triglycerides in the blood, while increasing levels of good” cholesterol . It can lower the build-up of cholesterol plaque in your blood vessels and arteries that could lead to a heart attack.
It does this by blocking an enzyme known as 3-hydroxy-3-methylglutaryl coenzyme A reductase in the liver. Blocking this enzyme helps to lower the production and increase the removal of bad cholesterol from your body.
Statins typically start to lower your cholesterol levels in about 2 weeks. Roughly two months after you start statin therapy your doctor will check your cholesterol levels with a simple blood test to see how well the drug is working.
Related Information: Cholesterol Testing: What Do Your Results Mean?
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Crestor Can Be Taken With Or Without Food Any Time Of The Day
The CRESTOR tablet should be swallowed whole. Do not take 2 doses of CRESTOR within 12 hours of each other.
- CRESTOR dose range: 5 mg40 mg once daily the usual starting dose is 10 mg20 mg once daily
- The 40 mg dose of CRESTOR should only be used for patients who do not reach a bad cholesterol goal on the 20 mg dose
On follow-up visits, your doctor may choose to adjust your dosage. Use the pictures above to identify your dose. And, of course, if you have any questions, always ask your doctor or pharmacist.
- Have loss of appetite, upper belly pain, dark urine, or yellowing of skin or eyes
Talk to your doctor about prescription CRESTOR.
What About Using Red Rice Yeast Or Plant Stanols Instead Of Prescription Drugs To Lower Cholesterol
Many people say they prefer to take natural medicines over prescription drugs. However, just because something is natural doesnt mean that its safe. In the U.S., supplements are not regulated as closely as medicines. Supplements can also interfere in dangerous ways with medications that you already take.
However, red rice yeast extract does contain lovastatin, which is the same chemical that is in Mevacor. In some cases, you and your healthcare provider might agree that you should try the supplement with monitoring.
Plant stanols are another nonprescription choice for lowering cholesterol. Plant stanols work by stopping the body from absorbing cholesterol in the intestines. One brand is CholestOff® capsules, while plant stanols are also available in margarine substitutes like Benecol®.
How to take your cholesterol-lowering medicines
When you are taking medicines, it is important to follow your healthcare providers advice carefully. If you dont take medicines exactly as prescribed, they can harm you. For example, you could unknowingly counteract one medicine by taking it with another one. Medicines can make you feel sick or dizzy if not taken properly.
Taking your medicine
Dont decrease your medicine dosage to save money. You must take the full amount to get the full benefits. If your medicines are too expensive, ask your provider or pharmacist about finding financial assistance. Some companies provide discounts for certain medications.
A note from Cleveland Clinic
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What Are The Typical Dosages Of Lipitor
Your doctor will typically follow dosage recommendations and guidelines for your condition based on studies of the drug. Theyll determine the right dosage for you and adjust your dosage over time if needed.
The starting dose and maximum dose of Lipitor youre prescribed may depend on:
- the condition being treated
- any health risk factors you may have
- other medications you may be taking
The typical dosage range of Lipitor is 10 mg to 80 mg taken once per day.
The normal starting dosage is 10 mg to 20 mg taken once per day. But if you have very high cholesterol, your doctor may have you start with a dosage of 40 mg taken once per day. Your doctor will check your cholesterol levels after a few weeks to see how well Lipitor is working for you. They may adjust your dosage at this time if needed.
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How Do Doctors Decide Who Is Prescribed A Statin
- Have clinical atherosclerotic cardiovascular disease , including those with a personal history of stroke, heart attack, or peripheral vascular disease, and also those who suffer from chest pains
- Have high cholesterol
- Are age 40 to 75 and have diabetes
- Are age 40 to 75 and have an estimated 10-year risk of an ASCVD event greater than 7.5 percent
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What’s The Least Expensive Cholesterol Medication In 2021
Statins are a type of medication prescribed to treat high cholesterol by lowering cholesterol production in the liver. According to our research, the average retail cost of statins used to treat moderate cases of high cholesterol is $139.29 for generic medications and $360.43 for brand-name statins.
For $45 per month, Mira members get access to low-cost lab testing, affordable urgent care visits, and MiraRx can help you access various statins at discounted prices and compare prices at different pharmacies.
Note: This article is meant for informational purposes only. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room. If you have questions about high cholesterol and treatment options, you should talk to your doctor.